title: Simple versus complex truncus arteriosus: neutralization of risk but with increased resource utilization.
abstract: This study examined simple versus complex forms of truncus arteriosus (TA) results in the current era with regard to mortality, reintervention, and resource utilization. From 1999 to 2008, 42 infants underwent primary repair of TA, including 22 simple forms of TA without associated anomalies and 20 complex forms with risk factors such as interrupted aortic arch (n = 8), coarctation (n = 1), significant truncal valve regurgitation (n = 6), discontinuous pulmonary arteries (n = 3), and truncal valve stenosis (n = 2). There were 4 early deaths (4/42, 9.5%), with no difference between simple TA (2/22, 9.1%) and complex TA (2/20, 10%). Early mortality decreased to 1 patient (1/23, 4%) in the most recent era: 2003-2008. Late mortality occurred in 4 (4/38, 10.5%). Reintervention was required in 12 patients, a median of 2 years postoperatively: for conduit reasons in 8 and combined conduit and truncal valve insufficiency in 4. Actuarial survival was 82% ± 7% at 5 years and freedom from reintervention was 52% ± 17% at 5 years, which are not different between complex and simple forms. Complex TA, age, and weight were not predictors on multivariable analysis for early or late death or reintervention. Complex TA had significantly longer (P < .05) median length of stay (17 vs 13 days) and intensive care unit intubation times (8 vs 5 days) versus simple TA. Complex TA does not have a higher operative or late mortality risk or increased risk of reintervention compared with simple TA. However, complex patients can be expected to have increased resource utilization as compared with simple forms of TA.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Primary Children's Medical Center, Salt Lake City, UT, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Hawkins
authors.forename: Aditya K
authors.initials: AK
authors.lastname: Kaza
authors.forename: Phillip T
authors.initials: PT
authors.lastname: Burch
authors.forename: Linda M
authors.initials: LM
authors.lastname: Lambert
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Madolin K
authors.initials: MK
authors.lastname: Witte
keywords: congenital heart disease–truncus arteriosus; health economics; outcomes